low intestinal obstruction
Introduction
Introduction Low intestinal obstruction is a clinical manifestation of intestinal obstruction. Intestinal obstruction (ileus) refers to the intestinal contents being blocked in the intestine.
Cause
Cause
(1) Causes of the disease
1. According to the cause of intestinal obstruction can be divided into 3 categories
(1) Mechanical intestinal obstruction: common causes are:
1 Intestinal foreign bodies: intestinal stones, parasites, large gallstones and fecal blocks are blocked or incarcerated.
2 intestinal polyps, new organisms, benign or malignant tumors or lymphoma blockage.
3 intussusception.
4 intestinal congenital anomalies: including congenital intestinal atresia, congenital fibrous curtain or hernia in the intestine, Merkel diverticulum stenosis. Congenital anomalies in the intestine are generally less common.
5 intestinal or peritoneal inflammatory lesions: such as intestinal tuberculosis, Crohn's disease, tuberculous peritonitis, radiation enteritis and NSAIDs and other drugs caused by intestinal inflammatory ulcers caused by narrowing.
6 intestinal adhesions: often due to abdominal or pelvic surgery, or intra-abdominal chronic inflammatory lesions (such as tuberculous peritonitis, Crohn's disease, etc.). Intestinal adhesions occur after surgery, and there are many intestinal adhesions.
7: such as inguinal hernia, intra-abdominal hernia, including the intima of the omental sac, femoral hernia and other incarceration.
8 intestinal torsion: reversal is more common in mesenteric tumors or basal stenosis and other reasons.
9 extra-intestinal tumors and other compression: such as intra-abdominal, omental, mesenteric giant tumors, giant retroperitoneal tumors, pancreatic pseudocysts, etc. can cause intestinal tube compression, severe intestinal obstruction. In recent years, intestinal obstruction caused by extraintestinal compression has increased.
(2) dyskinesia intestinal obstruction: dysmotility intestinal obstruction is due to intestinal muscle muscle activity disorder, resulting in intestinal contents can not run, rather than intestinal diseases inside and outside the intestinal cavity caused by intestinal obstruction, it is also known as pseudo-intestinal obstruction . The causes are:
1 paralytic ileus after surgery: common after surgery.
2 non-surgical paralytic ileus: common in:
A. Electrolyte disorders (especially abnormal potassium, sodium, magnesium).
B. A variety of systemic or intra-abdominal inflammation, such as sepsis, intra-abdominal abscess, severe pancreatitis and pyelonephritis, pneumonia.
C. Heavy metal poisoning.
D. Uremia.
F. myelitis.
G. Hypothyroidism.
3 Intestinal obstruction caused by intestinal muscle activity disorder due to lesions such as intestinal smooth muscle disease or intermuscular nerve plexus. Often referred to as chronic pseudo-intestinal obstruction, more common in the following lesions:
A. Intestinal smooth muscle lesions: such as progressive systemic sclerosis, connective tissue disease, amyloidosis, radioactive damage, and mitochondrial myopathy. Chronic pseudo-intestinal obstruction is also often associated with primary familial visceral myopathy.
B. Intestinal myenteric plexus lesions: can be seen in: a. neurogenic intestinal dysplasia, isolated intestinal dysplasia with neurofibromatosis, or with multiple endocrine neoplasia and myotonic dystrophy. b. A variety of recessive and dominant hereditary diseases. c. sporadic visceral neuropathy (including non-inflammatory degenerative diseases and degenerative inflammatory diseases such as American trypanosomiasis, cytomegalovirus infection, etc.). d. Developmental abnormalities of the enteric nerve or plexus, such as the myenteric plexus maturation disorder (often accompanied by central nervous system dysplasia and neuronal abnormalities), and total colonic ganglion cell deficiency.
C. Neuronal diseases: can be seen in Parkinson's disease, selective acetylcholine dysfunction and brain stem tumor after EB virus infection.
D. Metabolic endocrine diseases: seen in mucinous edema, pheochromocytoma, hypoparathyroidism, acute intermittent porphyria.
F. Intestinal diverticulosis: seen in small intestine diverticulosis with similar progressive systemic sclerosis, with visceral neuronal disease and neuronal inclusions in nerve cells.
G. Drug factors: found in the application of phenothiazines, tricyclic antidepressants, clonidine, opiates, vincristine and narcotic bowel syndrome.
7 Others: secondary to sclerosing mesenteric inflammation, steatorrhea, and lipidosis.
(3) Acute ischemic intestinal obstruction: caused by a blood supply to the intestine. Often can cause intestinal muscle activity to disappear, such as intestinal blood supply can not be restored, the intestinal tube is prone to necrosis, especially the intestinal tube through the end of the blood supply. Intestinal blood supply disorders are more common in mesenteric arterial thrombosis or embolism caused by various causes, as well as mesenteric venous thrombosis.
2. According to the blood supply of the intestine, it can be divided into 2 categories.
(1) Simple intestinal obstruction: only the intestinal contents are difficult to pass, and there is no intestinal blood supply disorder. However, simple intestinal obstruction can evolve into strangulated intestinal obstruction.
(2) strangulated intestinal obstruction: manifested as obstruction of intestinal contents, accompanied by intestinal blood vessel disorders.
3. According to the degree of obstruction can be divided into 2 categories
(1) Complete intestinal obstruction: the contents of the intestines could not pass at all.
(2) Incomplete intestinal obstruction: part of the intestinal contents can still pass through the obstruction, and incomplete intestinal obstruction can evolve into complete intestinal obstruction.
4. According to the obstruction site can also be divided into 3 categories
(1) high intestinal obstruction: generally refers to obstruction occurring in the duodenum and jejunum.
(2) low-grade small bowel obstruction: generally refers to obstruction occurring in the distal ileum.
(3) Colonic obstruction: generally occurs in the left colon, especially in the sigmoid colon or sigmoid colon and rectal junction.
5. According to the onset of illness can be divided into 2 categories
(1) acute intestinal obstruction: strangulated intestinal obstruction is generally acute intestinal obstruction, but also complete.
(2) chronic intestinal obstruction: chronic intestinal obstruction is generally incomplete, incomplete intestinal obstruction is generally simple intestinal obstruction. Chronic intestinal obstruction can also evolve into acute.
Examine
an examination
Related inspection
Small bowel filling and emptying function check small bowel angiography
High intestinal obstruction frequently vomits and bloating is mild, low intestinal obstruction is reversed, the clinical manifestations of colonic obstruction are similar to low intestinal obstruction, but X-ray abdominal plain film examination can distinguish small intestinal obstruction is inflatable intestinal fistula throughout the whole abdominal fluid level More, while the colon does not show, if it is colonic obstruction, the expansion of the colon around the abdomen and the accumulation of gas in the pocket-shaped small intestine is not obvious.
Diagnosis
Differential diagnosis
1. Chronic intestinal pseudo-obstruction
Chronic intestinal pseudo-obstruction is a syndrome with evidence and signs of intestinal obstruction but no evidence of mechanical obstruction. Paralytic ileus is acute intestinal pseudo-obstruction as described above. Here, we introduce chronic intestinal pseudo-obstruction. The intrinsic is the result of neurodegeneration of the intestinal wall. In the pathological examination, some cases show ganglion lesions of the intestinal plexus, but there are also cases of intestinal smooth muscle lesions. There is a manifestation of familial visceral myopathy. Such as small intestine and bladder smooth muscle degeneration and fibrosis due to the fact that family members have a family history suggesting that heredity is genetically related.
Symptoms and mechanical obstruction in patients with multiple symptoms at the age of ~ or adolescence at the age of ~ usually occur in acute and recurrent episodes of repeated episodes. Similar to varying degrees of nausea, vomiting, colic, abdominal pain, diarrhea or steatorrhea, and abdominal tenderness. During the remission period, there may be no or only mild symptoms such as bloating.
2, high intestinal obstruction frequent vomiting and abdominal distension is light, low intestinal obstruction is vice versa, the clinical manifestations of colon obstruction is similar to low intestinal obstruction, but X-ray abdominal plain film examination can distinguish small intestinal obstruction is inflatable intestinal fistula throughout the whole abdomen The level is more flat, while the colon does not show. If it is a colonic obstruction, the gas in the dilated colon and the small intestine around the abdomen is not obvious.
